Lin Xue-juan, Chen Chao-yang
Institute of Basic Medicine, Guzhou University of Traditional Chinese Medicine, Guangzhou 510405, China.
Zhongguo Zhong Yao Za Zhi. 2007 Feb;32(3):186-91.
Lumbar disk herniation (LDH) is a common orthopaedic disorder. Many clinical and basic science researches have been conducted recently on using Chinese medicinal herbs to treat LDH. Literature review reveals that the common basic formulas include Duhuo Jisheng decoction (DHJST), Buyang Huanwu decoction (HYBWT), Shentong Zhuyu decoction (STZYT), Taohong Siwu decoction (THSWT), Yanghe decoction (YHT) and Tongdu Huoxue decoction (TDHXT). A basic formula can be modified by adding more herbs or removing some herbs from the formula according to clinical symptoms and traditional Chinese medicine (TCM) syndrome differentiation. Literatures show that herbal treatment have better clinical effects, the medicinal herbs make low-back pain, sciatica and low limb numbness disappeared or alleviated; and restore normal low limb sensation, muscle strength and daily activity. These formulas have also been used to treat LDH postoperative remaining pain, postoperative discitis, postoperative recurrent LDH, and to prevent epidural scar formation and dura mata adhesion. Herbs in these formulas include 5 categories of drugs classified by TCM. They are blood circulation promoting herbs for relieving pain; liver and kidney nourishing and tendons and bones strengthening herbs; blood circulation promoting herbs for unblocking collaterals; pathogenic wind and dampness expelling herbs; and qi invigorating herbs. These herbs have actions of analgesia, anti-inflammation, immunomodulation, phagocytosis of macrophages enhancement, blood circulation improvement, nerve protection, collagen synthesis enhancement. Future research needs to focus on the effects of herbs on four aspects: to enhance collagen synthesis in the disks and inhibit disk degeneration; to promote the resorption of herniated nucleus pulposus and epidural hemorrhage; to prevent nerve cell apoptosis and promote nerve cell regeneration, and to inhibit nociception in the nerve system.
腰椎间盘突出症（LDH）是一种常见的骨科疾病。近年来，针对使用中药治疗LDH开展了许多临床和基础科学研究。文献综述显示，常见的基础方剂包括独活寄生汤（DHJST）、补阳还五汤（HYBWT）、身痛逐瘀汤（STZYT）、桃红四物汤（THSWT）、阳和汤（YHT）和通督活血汤（TDHXT）。基础方剂可根据临床症状和中医辨证，通过添加更多药物或去除方剂中的某些药物进行加减化裁。文献表明，中药治疗具有较好的临床效果，可使腰痛、坐骨神经痛和下肢麻木消失或减轻；恢复下肢正常感觉、肌肉力量和日常活动。这些方剂还被用于治疗LDH术后残留疼痛、术后椎间盘炎、术后复发性LDH，以及预防硬膜外瘢痕形成和硬脊膜粘连。这些方剂中的中药包括中医分类的5类药物。它们是活血化瘀止痛类药物；滋补肝肾、强筋健骨类药物；活血通络类药物；祛风除湿类药物；以及补气类药物。这些中药具有镇痛、抗炎、免疫调节、增强巨噬细胞吞噬作用、改善血液循环、神经保护、增强胶原蛋白合成等作用。未来的研究需要聚焦于中药在四个方面的作用：增强椎间盘内胶原蛋白合成并抑制椎间盘退变；促进突出髓核和硬膜外出血的吸收；预防神经细胞凋亡并促进神经细胞再生，以及抑制神经系统的伤害感受。
